[The physician's visit, the general physician, and his or her role].
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Family Practice↗
Biomedical subjects
L Bonomo
Publications and source records attributed to L Bonomo.
Color Doppler flow imaging of renal disease. Value of a new intravenous contrast agent: SH U 508 A (Levovist).
This study was aimed at assessing the diagnostic value of a new intravenous contrast agent SH U 508 A (Levovist) in improving color Doppler detection of renal mass vascularity. The study included 30 patients with renal masses: 22 adenocarcinomas, 1 sarcoma, 1 leiomyosarcoma, 1 urothelioma, 1 hemorrhagic cyst and 4 angiomyolipomas. The vascularization of the renal masses was investigated by means of color Doppler US, before and after the intravenous injection of SH U 508 A (Levovist), on the basis of blood flow patterns within and around the lesions. At precontrast scanning, low color Doppler signal at the periphery or within the lesions was observed in 13/30 patients only. After contrast administration, the signal-to-noise ratio increased, which allowed the visualization of tumor vessels in 26/30 patients. In 4/30 patients only no major enhancement of tumor vessels was observed. Our experience suggests that SH U 508 A (Levovist) improves color Doppler sensitivity in depicting the tumor vessels which were missed at baseline exams and in evaluating renal vein and inferior vena cava involvement.
Color↗
Reproducibility of ultrasound measurement of pancreatic size with new advanced high-resolution dynamic image scanners.
The reproducibility of ultrasound measurements of the pancreas was investigated in 10 healthy volunteers. All subjects underwent three different evaluations, each consisting of three ultrasound examinations, at 8:00 after overnight fasting, at 12:00 after a solid, standard meal, and at 14:00. The longitudinal and anteroposterior (AP) diameters of the head, body, and tail, as well as the total areas of the gland, were measured in longitudinal and axial scans. Significant differences were observed in the head and body longitudinal diameters measured at 12:00 and in the tail AP diameter at 14:00. We conclude that ultrasonography of the pancreas should be performed in the morning with patients in the fasting state. In these conditions, the reliability of ultrasound measurements of the gland appears to be the highest.
Adult↗
MRI alterations as an early finding in Creutzfeld-Jakob disease.
Two cases of Creutzfeldt-Jakob Disease (CJD) are reported. In both cases, pathologically confirmed, magnetic resonance imaging (MRI) showed bilateral altered signal areas in the basal ganglia, early in the course of the disease. The CT scan, although performed later than MRI, confirmed these findings. Only in one patient did electroencephalography (EEG) show typical triphasic sharp-waves, but this support to clinical diagnosis was obtained 1 month after the appearance of MRI alterations.
Brain↗
CD5+ B lymphocytes and CD4+ CD45RA+ T cells in Graves' disease.
Fifteen patients affected by new-onset Graves' disease with ophthalmopathy have been examined for lymphocyte subset phenotypes by two-colour cytometric analysis. CD5+ B cells were significantly increased in comparison to the normal population (43.2 +/- 20.6% versus 19.5 +/- 6.9%; p < 0.0009); total T cells showed a normal amount (70.4 +/- 9.6%), but the levels of THLADR+ cells were significantly increased in comparison to the control group (13.7 +/- 10.5% versus 4.7 +/- 3.2%; p < 0.007). The characterization of the subset suppressor-inducer CD4+ CD45RA+, evaluated as percentage of the total CD4+ T cells, showed a significant decrease in comparison with the control group (43.8 +/- 13.5% versus 52.3 +/- 6.5%; p < 0.03). Serum immunoglobulin evaluation showed a statistically significant increase of IgM (p < 0.05) and a significant decrease of IgA (p < 0.02). A statistical correlation between IgM levels and percentage of CD5+ B cells has been found (p < 0.04). The defect of suppressor-inducer T cell subset, along with the increase of CD5+ B cells may contribute to the pathogenetic mechanism of the disease in patients with a genetically-induced aberrant immune response.
Adult↗
Expression of CD69 antigen on synovial fluid T cells in patients with rheumatoid arthritis and other chronic synovitis.
OBJECTIVES: The expression of the CD69 antigen on synovial fluid and peripheral blood lymphocytes was studied in 12 patients with rheumatoid arthritis (RA), five subjects with other forms of chronic synovitis, and on the peripheral blood lymphocytes of 15 patients with systemic lupus erythematosus (SLE) and immune vasculitis. METHODS: The CD69 antigen and other activation markers (HLA-DR, interleukin 2 receptor (IL-2R), transferrin receptor) were measured by cytometric analysis. In patients with RA soluble IL-2R was determined by enzyme linked immunosorbent assay (ELISA). RESULTS: The percentage of T cells bearing CD69 was significantly increased in synovial fluid from patients with RA (30.3 (13)%) and other chronic synovitis (18 (9)%). The expression of CD69 on peripheral blood lymphocytes of patients with RA, other chronic synovitis, and SLE and immune vasculitis was within the normal range 2.1 (1.2)%. According to previously published work, a high proportion of synovial fluid T cells are HLA-DR positive (64.2 (12.4)% in synovial fluid from patients with RA and 61 (1.2)% in synovial fluid from patients with other chronic synovitis). Transferrin receptor expression on synovial fluid was up-regulated compared with that on peripheral blood. The increase of IL-2R expression on synovial fluid lymphocytes v peripheral blood was not significant; the quantitative determination of soluble IL-2R levels gave a mean value of 921 (351) U/ml in synovial fluid of patients with RA, 672 (229) U/ml in the serum of the same patients, and 273 (100) U/ml in serum from normal subjects. CONCLUSIONS: Synovial fluid lymphocytes are in a different functional state than peripheral blood lymphocytes. CD69 antigen is an interesting cellular marker which should be studied in patients with chronic synovitis. The unusual expression of the activation antigens and the sequence of their appearance require further study.
Antigens, CD↗
[Percutaneous transluminal renal angioplasty. Italian experience at 13 centers].
The data relative to 13 years' experience with percutaneous transluminal renal angioplasty (PTRA) in the 13 major interventional radiology centers in Italy were collected and analyzed to evaluate technical and clinical results. Our aim was to collect homogeneous results in a large series of patients, evaluating both the technical and the clinical success with a long-term follow-up (1 month-13 years). One thousand three hundred forty seven PTRA procedures (including 42 restenoses) in 1,073 patients were retrospectively reviewed. In 807 cases the cause of stenosis was atherosclerosis, in 442 cases fibromuscular dysplasia and in 24 cases arteritis in 12 cases, stenoses were present in patients that had undergone a surgical by-pass. Sixty-two stenoses in patients with solitary kidney and 102 in patients with renal failure were studied separately. The technical success (based on the morphology of the dilated tract) obtained in 91% of cases was considered, together with the clinical success (in 81% of cases), based on the decrease in blood pressure evaluated according to Martin's classification. The blood pressure values collected after the maneuver were also evaluated separately for the different types of stenosis etiology: atherosclerosis, fibromuscular dysplasia or arteritis; moreover, blood pressure was studied in solitary kidney patients and in those with renal failure. Complications were classified as major (4.2%) and minor (4.9%). The high success rate and the low incidence of complications we observed in our series suggest PTRA as the procedure of choice for high blood pressure patients with renal artery stenosis > 50% of the normal caliber.
Adolescent↗
[Volumetric computerized tomography (spiral CT). Technical principles and possible applications in the thorax].
Spiral volumetric CT is a new volume scanning technique allowing the one-acquisition imaging of an anatomical volume, by advancing the patient through a continuously rotating X-ray tube. As a result, the X-ray tube moves in spirals around the patient and this is the reason why this new technique is called Spiral CT. At the end of the acquisition, planar images are reconstructed by means of a dedicated image reconstruction algorithm with a linear interpolation between two contiguous spiral segments. Spiral CT offers many advantages, all resulting from the possibility of evaluating anatomical volumes in a short time: the organs which are subject to respiratory motion can be studied in a single breath-hold scan, the quality of secondary reconstructions (2/3 dimensional) is improved, the use of contrast media is optimal and finally motion artifacts are reduced. The authors report their early experience with spiral CT in the chest. Spiral CT is more reliable than conventional CT in the evaluation of pulmonary nodules, which can be easily identified with no risk of missing small lesions, and of the pulmonary apex and of the diaphragm. Moreover, contrast media can be used at a lower dosage than usually recommended with conventional CT.
Adolescent↗
[Peripheral pulmonary neoplasms: combined imaging (computerized tomography, ultrasonography, magnetic resonance) in the evaluation of chest wall involvement].
Chest wall involvement by a peripheral lung neoplasm, found in 4-8% of the cases, makes a difference in both staging and surgical approach. In the evaluation of the regional extent of the tumor, the radiologist must give the surgeon as much information as possible about relationships between lung neoplasm and chest wall structures, to correctly evaluate stage-T2 cancers and differentiate them from stage-T3 cancers. The authors report the results of a study made to assess the value of Computed Tomography (CT), ultrasonography (US) and Magnetic Resonance Imaging (MRI) to define chest wall invasion by a peripheral bronchogenic carcinoma. To this purpose 25 patients with primary peripheral lung neoplasm were studied with CT, US and MRI and the results were compared with surgical findings by means of TNM classification. Overall sensitivity and specificity were 68% and 74% for CT, 74% and 72% for US and 88% and 86% for MRI, respectively. CT, which still plays the major role in staging lung cancer, seems to get the worst results because of its impossibility to differentiate the cancers adjoining the chest wall from those showing signs of initial invasion. In these cases the use of the other imaging techniques (US, MRI) depends on their availability and on the specific experience of the radiologist.
Humans↗
[The trouts of the Thames].
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Fresh Water↗
[Mondor's disease. Report of 22 cases].
Mondor's disease is a rare pathology which is characterized from a superficial thrombophlebitis more frequently of a vein on the anterolateral thoraco-abdominal wall. The world literature reported about 500 cases which have been compared to 22 cases which represent our personal case-report. The most frequent etiological causes are represented by post-traumatic and infective events. The most important symptom is pain. The prognosis of the singol phlebitis focus is always favourable.
Adult↗
[The reform of Schedule XVIII].
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Education, Medical↗
[Abdominal aorta: role of angiography with magnetic resonance].
The diagnostic role of Magnetic Resonance angiography (MRA) was investigated in the study of the abdominal aorta. To obviate the problems relative to motion and respiratory artifacts, the TOF 2D (FISP 2D) technique was employed, together with a superconductive 1.5 T magnet. Fourteen volunteers were studied. The images acquired on the coronal and sagittal planes were processed according to MIP and target MIP, with a rotation on the z axis. The abdominal aorta was clearly demonstrated in 100% of cases, the celiac trunk in 42.8% of cases on coronal and in 100% on sagittal images. The superior mesenteric artery was depicted in 35.7% of cases on coronal and in 100% of subjects on sagittal acquisitions. The renal and iliac arteries were demonstrated in 100% of cases on coronal images only, while dorso-spinal and lumbar arteries were always clearly depicted on sagittal scans only. To evaluate the diagnostic reliability of MRA, 6 patients with abdominal aortic aneurysms were also studied and angiography and surgery were assumed as the gold standard. In all cases MRA yielded similar information to angiography and surgery as to aneurysm extent, vessel involvement and left renal vein course; moreover, MRA allowed the assessment of both the thrombotic and the calcific components of the aneurysm. Unenhanced MRA with the TOF 2D technique allows the detailed depiction of the aorta in about 20 minutes. Our preliminary results in the study of aneurysms are encouraging relative to the future diagnostic role of MRA in the abdominal aorta.
Aortic Aneurysm, Abdominal↗
[Angiography with magnetic resonance++ of the renal arteries: bidimensional versus tridimensional "time of flight" technique].
Twenty volunteers were examined by means of 2D and 3D time of flight (TOF) Magnetic Resonance angiography (MRA) of the renal arteries. The possible diagnostic applications of MRA were also evaluated in 6 patients with renovascular diseases. MRA examinations of the renal arteries were performed with a 1.5 T superconductive magnet (Magnetom Siemens) and circular body coil. Ten volunteers were studied with 3D FISP sequences (FA 25 degrees, TR 40 ms, TE 7 ms, ST 1 mm, Ma 256 x 256, FOV 500); the images were acquired on the axial plane and were rotated, in MIP and target MIP, on the axial (z) and sagittal (x) axes. The other 10 volunteers were studied with 2D FLASH sequences (FA 18 degrees, TR 300 ms, TE 8 ms, ST 4 mm, overlap 1 mm, Ma 256 x 256, FOV 500); the images were acquired on the axial and coronal planes and were rotated, in MIP and target MIP, on the axial (z) and sagittal (x) axes. The ostium and proximal segments (1-15 mm) were always easily identified with 2D and 3D sequences, the distal segments (16-35 mm) were also clearly demonstrated in 11 cases with 3D (55%) and in 16 cases with 2D (85%) sequences. The bifurcations and branch vessels of the renal arteries were easily depicted with 3D TOF sequences in 7 cases only. Combined 3D and 2D TOF images permitted the thorough evaluation of the renal arteries. In renovascular diseases, 2D and 3D TOF images clearly demonstrated occlusions and stenoses of the proximal segment (1-15 mm). 2D TOF sequences only permitted the visualization of a case of fibromuscular dysplasia in the distal segment. Our results suggest that 2D and 3D TOF MRA exhibits good potentials as a noninvasive screening technique for the evaluation of renovascular diseases.
Adult↗
Peripheral blood cell repopulation following high-dose cyclophosphamide.
High-dose cyclophosphamide can be used to obtain haematological stem cells from the peripheral blood. In this paper we analyse the dynamics of appearance of cells with these characteristics, together with the impact of this drug on the immunological system. Cyclophosphamide seems to possess immunomodulating effects even at high doses.
Antineoplastic Combined Chemotherapy Protocols↗
[Neoplastic involvement of pulmonary fissures. Diagnostic possibility of high resolution x-ray computed tomography].
Acknowledging fissure invasion by pulmonary tumors located in contact with or in the vicinity of a fissure is an important piece of information for the therapeutic choice, especially in patients whose functional respiratory impairments are a contraindication of pneumonectomy. Fifteen patients with pulmonary neoplasms adjacent to a fissure were studied with standard computed tomography (10 mm sections), completed by high-resolution CT. The findings of the CT studies were compared with those operative reports. On surgery, the oblique fissure was infiltrated in 12 patients, unharmed in 2 others, while the horizontal fissure was infiltrated in 3 patients. Standard CT allowed diagnosing the involvement of the oblique fissure in 4 patients. Thin sections with high-resolution reconstruction algorithms allowed detecting the involvement of the oblique fissure in 13 cases, including one false-positive result. On thin sections, the fissures appear as well-delineated, dense lines. This allows an accurate study of the relationships between the tumor and the fissure, thus increasing the sensitivity of CT for the detection of tumoral extension across the fissures. The orientation of the horizontal fissure, which is almost parallel to the plane of section, makes the study of its relationships with an adjacent mass difficult, even in high-resolution CT.
Humans↗
Role of interleukin 2, interleukin 4 and interleukin 5 in the T helper cell-driven B cell polyclonal differentiation in the elderly.
There is evidence for an impaired T cell-mediated B cell response during senescence. In thirty aged donors, pokeweed mitogen (PWM)-driven immunoglobulin (Ig) synthesis by B cells co-cultured with autologous enriched CD4+ lymphocytes and low amounts of monocytes, was evaluated. Under such experimental conditions, elderly cultures displayed a reduced IgG and/or IgM production when compared with the younger counterpart. Moreover, interleukin (IL)-2 and/or IL-5 addition to cultures led to an enhancement of Ig release. In contrast, IL-4 supplementation failed to positively modulate B cell differentiation. At the same time, aged cells cultured in the presence of IL-2 + IL-5 exhibited an increased Ig synthesis, while the addition of IL-2 + IL-4 or IL-4 + IL-5 mixtures did not induce any significant effect in comparison with homologous untreated samples. The results suggest a critical role for IL-2, IL-4 and IL-5 in the modulation of T helper cell-driven B cell polyclonal responsiveness in the elderly.
Aged↗
[Bronchogenic carcinoma staging: comparison of magnetic resonance/computerized tomography].
The staging of bronchogenic carcinoma is an important factor to select the appropriate treatment. Indeed, the definition of locoregional spread and of hilar and mediastinal node involvement is essential for both correct preoperative assessment and prognostic evaluation of bronchogenic carcinoma. CT and MR imaging are the methods of choice in the evaluation of T and N, even though other techniques--e.g., US and nuclear medicine--can also provide valuable diagnostic information. The authors examined 50 patients with primary bronchogenic carcinoma by means of plain radiographs, CT and MR of the chest. MR and CT findings were compared with surgical results on the basis of TNM classification. In the evaluation of T, sensitivity and specificity were 66% and 88.6%, respectively, for CT and 76% and 92% for MR imaging. No statistically significant differences were found between the two imaging methods (p = 0.19). In the evaluation of N, sensitivity and specificity were 56% and 78%, respectively, for CT and 76% and 88% for MR imaging. A statistically significant difference was found between MR and CT accuracy rates (p = 0.934). CT and MR results were in disagreement especially in the evaluation of hilar lymph nodes. To date, MR imaging cannot be considered a substitute for or a routine adjunct to CT in the staging of bronchogenic carcinoma due to its poor spatial resolution, to the presence of artifacts (especially with high-intensity fields), its cost and limited availability. However, in the evaluation of specific anatomical regions--e.g., the pulmonary apex and the peridiaphragmatic region--MR can provide more diagnostic information than CT thanks to its multiplanarity and better contrast resolution.
Humans↗